Biological Activities of Virgin Coconut and Virgin Olive Oil Mixture against Oral Primary Colonizers: An In Vitro Study.

AIM AND BACKGROUND: This study aimed to explore the potential synergistic interaction of virgin coconut oil (VCO) and virgin olive oil (VOO) mixture against Streptococcus sanguinis, Streptococcus mutans, and Lactobacillus casei in a single and mixture species through the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), antiadherence, and antibiofilm activities. MATERIALS AND METHODS: The broth microdilution technique was used to individually determine the MIC of both oils and an oil mixture (in the ratio of 1:1) in a 96-well microtiter plate. As for the MBC, the subcultured method was used. The fractional inhibitory concentration index (ΣFIC) was determined to identify the interaction types between both oils. The oil mixture at its MIC was then tested on its antibiofilm and antiadherence effect. RESULTS: The MIC of the oil mixture against the tested microbiota was 50-100%. The oil mixture was bactericidal at 100% concentration for all the mentioned microbes except S. mutans. The ΣFIC value was 2 to 4, indicating that the VCO and VOO acted additively against the microbiota. Meanwhile, the oil mixture at MIC (50% for S. sanguinis and L. casei; 100% for S. mutans and mixture species) exhibited antiadherence and antibiofilm activity toward the microbiota in mixture species. CONCLUSION: The oil mixture possesses antibacterial, antibiofilm, and antiadherence properties toward the tested microbiota, mainly at 50-100% concentration of oil mixture. There was no synergistic interaction found between VCO and VOO. CLINICAL SIGNIFICANCE: Children and individuals with special care may benefit from using the oil mixture, primarily to regulate the biofilm formation and colonization of the bacteria. Furthermore, the oil mixture is natural and nontoxic compared to chemical-based oral healthcare products. How to cite this article: Ng YM, Sockalingam SNMP, Shafiei Z, et al. Biological Activities of Virgin Coconut and Virgin Olive Oil Mixture against Oral Primary Colonizers: An In Vitro Study. J Contemp Dent Pract 2024;25(3):260-266.

Reliability, interrelationships, and minimal detectable changes of strength and power metrics among well-trained rugby sevens players.

Despite the importance of strength and power in rugby skills and match outcomes, there exists a noticeable gap in the measurement consistency and estimation of a true change of typical assessments designed to assess these qualities. To address this gap, we investigated the between-session reliability, interrelationships, and minimal detectable changes (MDC) of commonly used strength and power measures in team sports. Sixteen national-level rugby 7 s players were tested on two occasions, one week apart. Both the best and average (of 2-3 trials) peak force, peak power, height, distance, and/or strength indices during countermovement jump (CMJ), drop jump (DJ), isometric mid-thigh pull (IMTP), plyometric push-up (PPU), and standing long jump (SLJ) were obtained. Furthermore, one-repetition maximum (1RM) strength for bench press and back squat, reactive strength index, and dynamic strength index were also determined. Reliability was assessed using intraclass correlation coefficients (ICC) and coefficients of variation (CV), and used for MDC calculations, and interrelationships between variables were determined using correlation coefficients. Reliability was excellent for bench press, back squat, and SLJ (ICCs > 0.91); high to excellent for IMTP peak force, all CMJ, and DJ (except best DJ height and contact time), and PPU peak force parameters (ICCs > 0.78), with < 10% CVs (except PPU peak power). MDCs were generally smaller for average than best values. Large to very large relationships (r = 0.60 to 0.85) were observed between bench press, back squat, and IMTP with selected parameters of CMJ and PPU (p < 0.05), but not in DJ and SLJ. In conclusion, selected measures of strength and power displayed high to excellent reproducibility, with average values (rather than best) offering more stable assessments, and "smaller" MDCs. Based upon the relationships, it can be inferred that maximising strength would likely contribute to enhanced explosive performance.

The Efficacy of Apple Cider Vinegar at Different pH Values as an Antimicrobial Agent: An In Vitro Study.

AIMS AND BACKGROUND: This study evaluates the antimicrobial activities of commercially available 5% apple cider vinegar (ACV) against Enterococcus faecalis, Streptococcus mutans, and Lactobacillus casei. Materials and methods: Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were conducted using the broth microdilution method. Sodium hypochlorite (NaOCl) of 5.25% was used as a positive control, and comparisons were also made with acetic acid (AA) as the main ingredient in ACV. The three test bacteria treated with the most effective ACV dilution were visualized under a transmission electron microscope (TEM) for structural changes. RESULTS: Minimal inhibitory concentration was determined at 0.625% of the concentration of ACV against S. mutans and E. faecalis and 1.25% of the concentration of ACV against L. casei with two-fold serial dilutions. A concentration of 5 × 10-1% with 10-fold serial dilutions was found to be the MIC value for all three bacteria. No significant differences were found when compared with the positive control (NaOCl) (p = 0.182, p = 0.171, and p = 0.234), respectively, for two-fold serial dilutions and (p = 1.000, p = 0.658, and p = 0.110), respectively for 10-fold serial dilutions. MBC was observed to be 5% ACV for both E. faecalis and S. mutans. However, positive microbial growth was observed on the agar plate when cultured with L. casei. An independent sample t-test showed no significant differences (p > 0.05) in the antimicrobial activities between 5% ACV and 5% pure AA. TEM revealed cell wall and cytoplasmic membrane disruptions on all three bacteria at MIC value. CONCLUSION: Apple cider vinegar has antimicrobial activities against Enterococcus faecalis, Streptococcus mutans, and Lactobacillus casei at their respective MIC values. CLINICAL SIGNIFICANCE: Apple cider vinegar can be an alternative antimicrobial dental pulp disinfectant to sodium hypochlorite. Apple cider vinegar can be used safely, especially in children's dental pulp therapy and deep caries management, when adequate tooth isolation is not readily achievable. Thus, adverse reactions commonly associated with other frequently used chemical disinfectants can be avoided.

Effects of Eurycoma longifolia Jack supplementation on eccentric leg press exercise-induced muscle damage in rugby players.

Eurycoma longifolia Jack (ELJ) is a herbal plant that has androgenic and antioxidant effects. We investigated the short-term effect of ELJ supplementation on muscle damage induced by eccentric exercise. Eighteen young (19-25 years), well-trained rugby 7s players were assigned to an ELJ or a placebo (PLA) group (n = 9/group). Each participant took four 100-mg capsules a day for seven days prior to performing a leg press eccentric exercise to failure in a double-blind fashion. Peak force, peak power and jump height in countermovement jump (CMJ), drop jump reactive strength index (RSI), muscle soreness assessed by a 100-mm visual analogue scale, plasma creatine kinase (CK) activity, and salivary hormones were measured at 24 h before and 0.5, 24, 48, 72, and 96 h after the exercise. Changes in the variables over time were compared between the groups by two-factor mixed-design ANOVA. The number of eccentric contractions performed was similar (P = 0.984) between the ELJ (21 ± 5) and PLA groups (21 ± 5). Salivary testosterone and cortisol concentrations did not change (P > 0.05) after the supplementation for both groups. CMJ peak power (-9.4 ± 5.6%) and height (-10.6 ± 4.9%), and RSI (-15.2 ± 16.2%) decreased at 24 h after exercise (P < 0.05), and muscle soreness (peak: 89 ±10 mm) and plasma CK activity (peak: 739 ± 420 IU/L) increased after exercise (P < 0.05) without significant differences between groups. These results showed that 7-day ELJ supplementation prior to the leg press eccentric exercise had no significant effects on hormones, performance and muscle damage markers for the athletes.

Effectiveness of psychological techniques in dental management for children with autism spectrum disorder: a systematic literature review.

BACKGROUND: A rise in the reported numbers of children with Autism Spectrum Disorder (ASD) highlights the need for dental practitioners to be more familiar with the treatment approaches for these special needs children to ensure comfortable, well-accepted and efficient management while in dental office. AIM: This paper aimed to acquire a deeper understanding of some of the innovative and best approaches to managing children with ASD in dental settings. DESIGN: A systematic literature search was performed in PubMed, Scopus, Web of Science, Cochrane databases, and grey literature based on the PRISMA 2020 statement, using main keywords such as: 'management', 'dental', 'children', and 'Autism Spectrum Disorder'. Original full-text papers including randomised controlled trials (RCT) and all other designs of non-randomised controlled studies (NRS) reporting relevant intervention studies in English were included without any publication time limit. The quality of the evidence found eligible for the review were then assessed using the ROB-2 and ROBINS-I tools. Subsequently, the details of management interventions and impact of treatment approaches were compared and discussed. RESULTS: Out of the 204 articles found, 109 unrelated articles were excluded during the initial screening. The full papers of remaining 28 were retrieved and only 15 (7%) articles were eligible to be reviewed; eight RCTs with 'some concerns' and 'high risk' categories particularly concerning their randomisation design, and seven NSRs with 'serious' to 'critical' bias largely due to confounding factors. CONCLUSION: Our review found inconclusive evidence on the strength of recent psychological and non-pharmacological approaches used to manage children with ASD in dental settings. Small sample size and lack of a control group in certain studies affected the strength of evidence and credibility of the findings. Nevertheless, this review shared informative details on some innovative approaches for better understanding of the management of children with ASD for dental professionals.

Cognitive Impairment and Neuropsychiatry Manifestation Following Mild and Moderate Traumatic Brain Injury at 3 Months and 6 Months.

Background: Cognitive impairment (CI) and neuropsychiatry manifestation (NM) are known complications among patients with traumatic brain injury (TBI). However, the clinical correlation between mild and moderate TBI with the above have not been extensively studied. Methods: The patients (n = 54) were divided into mild and moderate TBI. Both groups were assessed at 3 months and 6 months post-trauma for the same measures. Diagnosis of CI was done using the Montreal cognitive assessment (MoCA) questionnaire while NM screening was performed using the 12-items General Health Questionnaire (GHQ-12) followed by MINI International Neuropsychiatry Interview (MINI). Results: We found five patients (19.2%) with mild TBI had CI and five patients (19.2%) had NM at 3 months. Only one patient (3.8%) persistently has CI at 6 months while the rest recovered. As for moderate TBI, 11 patients (39.3%) had CI and seven patients (25%) had NM at 3 months but none had persistent CI or NM at 6 months. Age (P < 0.05) and blood pressure were significant risks (P < 0.05) for CI and NM at 3 months. Conclusion: This study highlighted the importance of screening following mild and moderate TBI at 3 months and 6 months. Early recognition facilitates effective rehabilitation programmes planning hence improve prognosis in the future.

Patient Satisfaction Following Orthodontic Treatment: A Systematic Review.

Patient-reported outcome measures (PROMs) have become increasingly important in orthodontic treatment as they reflect patients' perceptions of treatment outcomes. Understanding patient satisfaction with orthodontic treatment is crucial for improving healthcare delivery and patient-centered care. This systematic review aimed to critically appraise the evidence regarding patient satisfaction after orthodontic treatment, exploring the effects of different treatment types, patient demographics, and other factors on satisfaction levels. Eight electronic bibliographic databases were searched without publication time or language restrictions, including PubMed®, Scopus®, the Cochrane Central Register of Controlled Trials, Web of Science™, Embase®, Google™ Scholar, Trip, and OpenGrey. A manual search was conducted on the references in the included papers. Eligibility criteria were established based on the Population, Intervention, Comparison, Outcomes, and Study (PICOS) framework. Studies were included if they reported patient satisfaction levels following orthodontic treatment using standardized questionnaires. Two reviewers independently collected and analyzed the data. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2) for randomized clinical trials, and the methodologic quality for cohort and cross-sectional studies was assessed using the modified version of the Newcastle-Ottawa scale. Fourteen studies employed various questionnaires and timings to gauge post-orthodontic treatment satisfaction. Patient satisfaction levels were generally high, with most studies reporting satisfaction rates above 91%. Fixed orthodontic appliances were associated with higher satisfaction levels compared to removable appliances. While age and gender did not significantly influence satisfaction, the quality of care and doctor-patient relationships were crucial factors in patient satisfaction. This systematic review proves that patient satisfaction with orthodontic treatment is generally high, with fixed appliances and positive doctor-patient relationships contributing to higher satisfaction levels. However, the quality of the evidence was moderate to low, highlighting the need for further high-quality clinical studies in this area.

Preliminary in vitro cytotoxic evaluation of Uncaria gambier (Hunt) Roxb extract as a potential herbal-based pulpotomy medicament.

BACKGROUND: The downfall of formocresol as a pulpotomy medicament highlights the importance of cytotoxic evaluation and the establishment of a safe concentration of dental material prior to its usage in the oral cavity. Uncaria gambir is an herbal plant that possesses antimicrobial, anti-inflammatory and antioxidant properties, suggesting its potential as an alternative medicament for pulpotomy. However, there are not many studies published on its cytotoxicity, with some using non-standardised techniques and reported variable outcomes. Here, we investigated the concentration and time-dependent toxicity of Uncaria gambir extract towards the M3CT3-E1 cell line and compared it with the gold standard pulpotomy medicament: mineral trioxide aggregate (MTA). METHODS: Uncaria gambir extracts at concentrations ranging from 1000 to 7.8 µg/ml and MTA eluates at 4- and 48 h setting times were prepared. 10% dimethyl sulfoxide (DMSO) and culture media were used as positive and negative controls respectively. Cell viability on days 1, 2, 3 and 7 was analysed using Alamar Blue and Live and Dead Cell assay. Any morphological cellular changes were evaluated using transmission electron microscopes (TEM). Data were analysed using a two-way mixed Analysis of Variance (ANOVA). RESULTS: The interaction between the concentration and exposure time on the fluorescence intensity of Uncaria gambir extract and MTA 48 h was found to be statistically significant (p < 0.001). No cytotoxic effects on the cells were exerted by both MTA 48 h and Uncaria gambir extract at a concentration below 500 µg/mL. TEM analysis and Live and Dead Cell assay for both materials were comparable to the negative control. No significant differences in fluorescent intensity were observed between Uncaria gambir extract at 500 µg/mL and MTA 48 h (p > 0.05). CONCLUSION: Uncaria gambir extracts at a maximum concentration of 500 µg/mL are non-cytotoxic over time and are comparable to the MTA.

What Is the Most Effective Frictionless Method for Retracting Anterior Teeth When Using Buccal Fixed-Appliance Therapy? A Systematic Review.

There are various techniques and designs for springs used in orthodontic treatment, including frictionless methods for closing spaces. However, there is limited explicit evidence to support the superiority of one method over another. This review aims to investigate the available evidence and highlight the advantages of these different methods. This review contained six papers, and information such as study design, spring design, applied force systems, variables studied, follow-up period, and records were extracted. All of the studies focused on canine retraction with the Ladanyi spring showing the highest rate of movement (1.8 mm per month) among all springs for upper canine retraction. The Gjessing and T-loop springs outperformed the Reverse Closing Loop and Ricketts spring, respectively, substantially. In terms of tip control, the T-loop spring showed a clear advantage over the modified Marcotte spring with a difference of 1.2° vs. 6.6° per 3 months. Additionally, it was observed that the Reverse Closing Loop caused a significant loss of anchorage during canine retraction with a medial movement of 2.4 mm. When comparing wire types, no significant differences were found between TMA and Nitinol, while stainless steel was found to be less effective in terms of movement rate and tip control. However, the results indicated that there was no clear evidence that one specific technique was definitively preferable to another; therefore, there is an urgent need for more studies with proper study designs to produce more robust conclusions.

Efficacy of Mobiderm® Bandage in Compression Therapy for Venous Ulcers: A Prospective Case Series.

Background: Venous leg ulcers severely affect patients' quality of life due to its high morbidity and recurrent nature. Currently, compression therapy is the first-line treatment for venous leg ulcers. Aim: This study sought to evaluate the efficacy of the Mobiderm® technology developed by Thuasne in a prospective case series of venous leg ulcers. Methods: Nine patients (N = 9) with venous leg ulcers were enrolled into this case series. Mobiderm® bandage was applied on to the affected limbs of the patients in the multi-component bandages system. The bandages were changed as frequent as the patients had their wound dressing for their standard treatment in a 12-week duration. Wound size and calf circumference were measured at week 0 and week 12. Paired sample t-test was used to compare the mean values of wound size and calf circumference pre- and post-treatment. Results: Reductions in wound size and calf circumference were observed in all nine patients (100%). Five patients were evaluable at week 12. The wound sizes significantly reduced by 27.2% to 53.2% (p = 0.02), and the calf circumferences significantly reduced by 3.2% to 26.0% (p = 0.02) after 12 weeks (N = 5). Safety was unremarkable, with no occurrence of treatment-emergent-related adverse event. Conclusion: Mobiderm® bandage was reported to be effective in promoting wound healing and reducing swelling, suggesting it to be integrated in the compression therapy for the management of venous leg ulcers.

Evaluation of the Impact of Orthodontic Treatment on Patients' Self-Esteem: A Systematic Review.

Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.

Resin Infiltration of Non-Cavitated Enamel Lesions in Paediatric Dentistry: A Narrative Review.

The resin infiltration (RI) technique was introduced as one of the minimal intervention dentistry strategies in addressing dental caries among the paediatric population. This technique used the low-viscosity resin monomer to infiltrate the non-cavitated carious lesion and other developmental enamel porosities, thus allowing the conservation of the tooth structure. This narrative review aims to explore the value of RI in Paediatric Dentistry. Through our search of the literature, the development of the material, their clinical applications and shortcomings, as well as the innovation that has been carried out to improve the current RI, were discussed. There are number of high-level evidence supporting the use of RI in arresting non-cavitated proximal caries lesions in primary and permanent teeth, but its efficacy in managing anterior white spot lesions is still unclear. Limited penetration depth, not radiopaque and questionable long-term colour and material stability were among the limitation of the material. Various laboratory-based studies have been conducted to improve the current properties of RI. Nevertheless, RI has emerged as one of the important micro-invasive techniques in addressing non-cavitated and anterior white-spot enamel lesions in children and adolescents with great success.

Prevalence of Coronavirus Disease 2019 (COVID-19) in Different Clinical Stages before the National COVID-19 Vaccination Programme in Malaysia: A Systematic Review and Meta-Analysis.

More than 1.75 million COVID-19 infections and 16 thousand associated deaths have been reported in Malaysia. A meta-analysis on the prevalence of COVID-19 in different clinical stages before the National COVID-19 Vaccination Program in Malaysia is still lacking. To address this, the disease severity of a total of 215 admitted COVID-19 patients was initially recorded in the early phase of this study, and the data were later pooled into a meta-analysis with the aim of providing insight into the prevalence of COVID-19 in 5 different clinical stages during the outset of the COVID-19 pandemic in Malaysia. We have conducted a systematic literature search using PubMed, Web of Science, Scopus, ScienceDirect, and two preprint databases (bioRxiv and medRxiv) for relevant studies with specified inclusion and exclusion criteria. The quality assessment for the included studies was performed using the Newcastle-Ottawa Scale. The heterogeneity was examined with an I2 index and a Q-test. Funnel plots and Egger's tests were performed to determine publication bias in this meta-analysis. Overall, 5 studies with 6375 patients were included, and the pooled prevalence rates in this meta-analysis were calculated using a random-effect model. The highest prevalence of COVID-19 in Malaysia was observed in Stage 2 cases (32.0%), followed by Stage 1 (27.8%), Stage 3 (17.1%), Stage 4 (7.6%), and Stage 5 (3.4%). About two-thirds of the number of cases have at least one morbidity, with the highest percentage of hypertension (66.7%), obesity (55.5%), or diabetes mellitus (33.3%) in Stage 5 patients. In conclusion, this meta-analysis suggested a high prevalence of COVID-19 occurred in Stage 2. The prevalence rate in Stage 5 appeared to be the lowest among COVID-19 patients before implementing the vaccination program in Malaysia. These meta-analysis data are critically useful for designing screening and vaccination programs and improving disease management in the country.

Simple Orthodontic Correction of Rotated Malpositioned Teeth Using Sectional Wire and 2 × 4 Orthodontic Appliances in Mixed-Dentition: A Report of Two Cases.

The correction of rotated malpositioned tooth/teeth into the dental arch alignment in the mixed-dentition is often a challenging task for paediatric dentists. Failure in addressing this issue can bring about detrimental effect to the developing dentition and increases the probability of a complex orthodontic treatment in later years. Factors such as severity of the malpositioned teeth, patient's treatment compliance, limitation in specific functions of the selected appliance, availability of bone and space may dictate the success of the treatment. The combined use of a simple sectional orthodontic wire appliance and a 2 × 4 orthodontic appliance has been shown to produce a positive effect. The appliances resulted in derotation of the rotated malpositioned teeth and bringing them into arch alignment in two cases. This treatment option had eliminated the detrimental effects to the developing dentition and helped patients to enhance their smile and dental aesthetics.

Sectional Fixed Orthodontic Extrusion Technique in Management of Teeth with Complicated Crown-Root Fractures: Report of Two Cases.

Complicated crown-root fractures account for a small percentage of traumatic dental injuries seen in children; however, management of these injuries can be very challenging to clinicians. Factors such as complexity of the injury, patient's age and dentition stage, patient's cooperation, and parental demands may have some bearing on the type of treatment undertaken and its outcomes. In some children, these injuries may have significant impact on their quality of life. The purpose of this article is to describe two cases of complicated crown-root fracture which were successfully managed through orthodontic extrusion using a sectional fixed orthodontic technique. The basis for the treatment technique and its favourable outcomes were highlighted with its advantages and drawbacks.

Maturogenesis of an Immature Dens Evaginatus Nonvital Premolar with an Apically Placed Bioceramic Material (EndoSequence Root Repair Material®): An Unexpected Finding.

Dens evaginatus is a dental developmental anomaly that arises due to the folding of the inner dental epithelium that leads to the formation of an additional cusp or tubercle on the occlusal surface of the affected tooth. This accessory tissue projection may carry with it a narrow and constricted pulp horn extension. Occasionally, the tubercle easily fractures, thus leading to microexposure of the pulp horn and eventual pulp necrosis. Often, the pulp necrosis occurs at a time the root development of the affected tooth is incomplete. Apexification with calcium hydroxide and mineral trioxide aggregates has been the mainstay of treatment options before root canal obturation in immature nonvital permanent teeth. Lately, regenerative endodontics (maturogenesis) is becoming one of the preferred treatment modalities to manage such teeth. The current case highlights the possibility of a bioceramic material (EndoSequence Root Repair Material, BC RRM-Fast Set Putty™, Brasseler, USA) which supposed to provide apical root closure (apexification) and could also induce continuation of root growth (maturogenesis).

Determining Spatial Resolution of Gamma Cameras Using MATLAB.

It is important to monitor the spatial resolution of a gamma camera on a weekly basis to acquire medical images with accurate quantitative information. A simple and fast computer program with a graphical user interface to analyze spatial resolution was successfully developed using MATLAB. The results were compared with those obtained from the standard processing system available in our gamma camera. The spatial resolution calculated using MATLAB was 1.24% lower than using the standard processing system. The developed program is cost effective, faster, and provides an easy platform for the physicists and technologists to analyze the spatial resolution based on the image of the line source.

Pregnancy with hypoplastic left lung complicated by pneumothorax and pulmonary embolism.

We report a case of a 34-year-old lady with past history of asthma and pulmonary tuberculosis, who presented 5 weeks pregnant with acute dyspnea. Her chest X-ray showed left-sided complete lung collapse and concomitant right-sided pneumothorax. The pneumothorax was initially managed conservatively with a chest tube but due to its persistence despite suction, was subsequently changed to a Pneumostat(TM), with which she was later discharged. She had a normal echocardiography (ejection fraction [EF] 67%) at 5 weeks of gestation but developed pulmonary hypertension (EF 55%, pulmonary arterial pressure 40.7 mmHg) as the pregnancy progressed. She delivered a healthy baby at 35 weeks via elective lower section caesarean section with spinal anesthesia. We followed her up postnatally and noted the presence of left-sided pulmonary embolism, hypoplastic left lung, and left pulmonary artery. The management of this complex case involved a multidisciplinary effort between general medical, respiratory, obstetric, and cardiothoracic teams.

Influence of Background Activity on Volume Estimation Using Iterative Thresholding Method in Single-Photon-Emission Computed Tomography with Technetium-99m: A Phantom Study.

INTRODUCTION: The aim of this study was to assess the influence of background activity on the accuracy of volume estimation of target objects using an iterative thresholding method. METHODS: Single-photon-emission computed tomography studies were carried out for plastic bottles of various sizes as target objects containing Technetium-99m placed in a cylindrical water phantom. The phantoms were created to have varying ratios of target activity concentration to background activity concentration (T/B) ranging from 4.00 to 1.25. From the single-photon-emission computed tomography slices, the volume of the target object was estimated using an iterative thresholding method. A unique threshold that estimated the volume of the target object was determined and declared as ideal threshold for each level of background activity. Simple linear regression analysis was carried out to explore the relationship between the actual volume and estimated volume. RESULTS: The analysis shows a statistically significant linear relationship (P < .01) between actual volume and estimated volume. For all ratios of target activity concentration to background activity concentration studied, the relative errors in estimated volumes of target objects are within ±7%. Thresholds that estimated volume of target objects vary depending on the level of background activity. CONCLUSIONS: It is clearly demonstrated that background activity highly influenced the volume estimation. Therefore, background activity of the target object needs to be considered when selecting the ideal thresholds to obtain accurate volume estimation of target objects.

Abdominal cocoon in association with adenomyosis and leiomyomata of the uterus and endometriotic cyst : unusual presentation.

Abdominal cocoon or sclerosing encapsulating peritonitis is a rare condition. A 46 year old Malay woman with adenomyosis and leiomyomata of the uterus and ovarian endometriotic cyst in association with abdominal cocoon is reported.